Toddler won't swallow or spit out food sometimes

Question

Sometimes around dinner my 21 month old toddler will eat reasonably well, and we don't try to force him to eat if he doesn't want anymore. He loves fruits, grains and meats and seems to tolerate vegetables.

We will let him down from his chair when he starts playing with his food, or throwing it at the dog, that is generally when he is not hungry anymore. We usually keep his plate up on the counter though because he doesn't always eat everything and 10 to 30 minutes later he will often try to reach for it because he would like another bite. When we give the other bite, he will just kind of let it sit in his mouth and he won't swallow it, sometimes for a half hour or more.

We have tried convincing him to swallow, giving him water or juice, bribing with a cookie, convincing to spit it out into our hands, he just doesn't seem to want to. I am not sure if it is a burgeoning rebellion in him but when we ask him to do something like this he gets this devious smile and joyfully tells us "NO".

It is concerning for me and I press it because he plays very rough and I am afraid he will choke on it. Thank god this hasn't happened yet.

I have also tried timeout but when I put him in his timeout chair he breaks down into a complete tantrum with wildly throwing his body back into his chair further increasing the risk he is going to choke. The last time I did this he begrudgingly swallowed but then gagged and threw up everywhere.

Is this behavior normal? Do you have any advice or suggestions to help with this situation? I don't want to not feed my child when they ask me for food.

Answer 1

There are a few possible causes.

• It may be that your son likes the taste or texture of dinner, even though he is not hungry, and therefore he chews on the food but isn't really motivated to swallow.

• It may be a control issue: he's essentially saying I don't have to swallow and you can't make me, and that grin definitely points (at least in part) to him declaring control over his own bodily functions.

  Anecdotally, I knew an adopted child who tended to hold food in her mouth around the same age; her parents' explanation for it was a scarcity of food when she was very young (in an orphanage) and so she'd "save" some for later. It's unlikely this is the reason your son doesn't want to swallow, but illustrates that wanting control over when food is eaten can be a strong motivator.

• It's possible there is a minor physiological problem with his chewing or swallowing, and so it's worth mentioning the behavior to your pediatrician (see below).

Whatever the cause or motivation, carrying food around in his mouth isn't particularly safe — as you noted, it's a potential choking hazard. A useful principle to keep in mind here is the division of responsibility in feeding.

The parent is responsible for what, when, where.
The child is responsible for how much and whether.

Most relevant to this situation is the where. There are lots of reasons a parent can dictate where — hygiene, clean floors, keeping the dog from stealing food out of the child's hand, and of course safety. If he really doesn't want to stay at the table while chewing and swallowing, it is very unlikely he's really hungry (or, swallowing is harder than usual).

• "I'm glad you liked your dinner, you can definitely have another serving! Let's sit back down at the table where you are supposed to eat."
• "I understand you're not hungry anymore and you're ready to go play, but you need to swallow your last bite before you leave the table."

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_{A bit more detail about why consulting the pediatrician can be helpful, just to rule out physiological causes:}

1. _{Children who pocket food should be checked out by an occupational and speech therapist, even if they have had no other type of therapies or been diagnosed with any medical conditions... those specialists can make sure there are no other problems, such as difficulty moving food around in their mouth with their tongue or if the tongue is weak. These children can usually be cured with basic therapy exercises to overcome these obstacles. (Source)}

2. _{discuss your child's feeding behavior with your pediatrician to rule out a chewing or swallowing problem that needs intervention from a trained feeding expert. Although hoarding food in his mouth every now and then may not be cause for concern, doing it for too long can increase choking risk or have other adverse nutritional and health consequences if the behavior persists. (Source)}

Answer 2

I don't know if the behavior is "normal", but it's certainly something I've heard of before (though not something my kids have done).

It's probably largely what you say - a small rebellion. Children around two are learning that they have some control over things, and they like seeing what that entails. One of the things he has control over is eating - and swallowing.

I see several good ways to deal with this.

• While he's in his highchair, ask him to finish his bite before he gets down. If he says "No" or ignores you, explain to him why you need him to do it - specifically, that you don't want him to choke. If he's sufficiently verbal to explain why he is doing it - ask! Maybe he likes the texture in his mouth, or maybe he likes the taste. Perhaps see if you can find a compromise - maybe a food that isn't a choking hazard you allow (ie, something squishy that will dissolve).
• Allow him to leave the table with food in his mouth, but restrict his activities. If it's something that he really wants to do, fine, but no roughhousing or running around: only very quiet, sitting activities, until his mouth is empty. Again, explain to him why here: authoritarianism is all well and good, but a child who knows why he shouldn't do something won't do it when you're not watching.
• Give him a drink at the end of every meal that is something he enjoys (milk, for my kids, would do fine here). Since he can't drink without swallowing, you have him good to go. Remove the food from the table before he has his drink.

I don't know that time-outs are likely to be particularly effective here, because this isn't something that's coming from him being out of control. They might work simply as a way of getting him into a calm, unlikely to cause chocking state, but it sounds like that's not true. Time outs also are much less effective before three years old, so that may be part of the problem.

Honestly, I wouldn't be surprised if a few days of calmly explaining why it's dangerous for him don't do the trick by itself; he's old enough to understand danger, and I'm sure he's had mild choking incidents before to have a reference point.

Answer 3

My 3.5 year old does the same for very long. I tried every possible thing to make him eat, but he has his own pace of chewing and swallowing. The most likely reason for his behaviour that I find is that he has tonsillitis so maybe he finds it difficult to finish his bite quickly.

Answer 4

If everyone at the table is eating together then when everyone is done your child should either swallow or spit the food. No food after that last bite and continue your night routine. He won't starve! If you are not eating together maybe set an egg timer so he knows how long is a reasonable amount of time to eat his food. When the timer is up dinner is over, even if he is still chewing his first bite. Don't talk about it and just go on with your day. He will be hungry soon enough and will realize that there is no more food until the next meal. Eventually he will eat his food it's a phase kids go through the more attention given the more frustrated the parents will get.